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This research is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0614-34079).

Background

Approximately 60,000 children/young people are in foster care in England, with over 50% due to abuse and neglect. Consequently a large number of fostered children present with emotional and behavioural difficulties. The most effective treatment for this group is currently unknown.

Herts and Minds is a trial of a therapy for children in foster care adapted from Mentalization-Based Treatment (MBT). In working with looked after children and their foster carers, MBT aims to promote the quality of relationships, support effective and sensitive foster care, and help carers to help the child in their care understand and manage emotions better. The focus is on improving the core components of secure attachment, including collaboration, and parental (or carer) reflective capacity. The approach also pays attention to developing reflective practice for all professionals working with looked after children

There is a growing body of evidence for the use of MBT in the treatment of adults with borderline personality disorder (BPD), and some evidence that this is an effective treatment for adolescents who self harm. To date, there has been no systematic test of MBT as an intervention for children in foster care with emotional and behavioural difficulties.

Aims

The overall aim is to ascertain the effectiveness of MBT as a treatment for children in foster care presenting with emotional and behavioural difficulties.

Before embarking upon a large scale trial, this feasibility study aims to:

to test capacity to train mental health practitioners to an acceptable level of treatment integrity

to assess the feasibility of recruitment processes and uptake to the study

to establish acceptability and credibility of MBT as a treatment intervention for looked after children

to establish the feasibility and acceptability to families of conducting a randomised clinical trial

to establish the feasibility of collecting resource-use data, for the purpose of calculating relative cost-effectiveness; and to constrain a preliminary estimate of likely treatment efficacy effect size

Methodology

The study is a two-arm, parallel group, single centre feasibility randomised trial and will be conducted over a 24 month period. The study will be conducted in a Targeted CAMHS service within a single NHS Trust: Hertfordshire Partnership University NHS Foundation Trust (HPFT).

A total of 42 looked after children and their foster carers will be recruited from routine referrals to the CAMHS targeted team. Children and their primary foster carer will be included if they are : primary- and secondary-school age children (aged 5-16); in foster-care (or kinship care) for a minimum of 4 weeks; referred to the Targeted CAMHS teamand accepted as an appropriate referral following an initial consult meeting with the professional network ; with emotional or behavioural problems (based on a score on the SDQ ≥15). Emergency crisis referrals will be excluded where an immediate response to a significant risk is required, or if the referrals is specifically for a psychiatric assessment in specialist CAMHS.

Following recruitment to the study (n=42), participants will be randomised to one of two treatment arms, MBT or care as usual. Both treatments are short-term (up to 12 sessions). MBT consists of a combination of psycho-education for foster carers, consultations with the professional network when required and direct relational work, tailored to the needs of each foster family, aimed at helping foster families understand their foster child’s needs and feelings, encouraging sensitive parenting and tackling problematic patterns of foster family interaction.

This project is ongoing and results will be updated once complete.

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